Making the Link:Making the Link:Protecting Health from Protecting Health from

Environmental ExposuresEnvironmental Exposures

Vi Waghiyi Sarah Petrasvi@akaction.net sarah@akaction.org

info@akaction.netwww.akaction.org

(907) 222-7714 phone(907) 222-7715 fax

Our mission: Our mission: To assure justice by advocating for environmental and community

health. We believe everyone has a right to clean air, clean water and toxic-free food.

Core Values: Core Values: Community right-to-know Environmental justice Precautionary principle Elimination of the production and release of toxics Rights and sovereignty of Indigenous peoples Culture of caring and wellness

Environmental Health and Environmental Health and Justice in AlaskaJustice in Alaska

Addressing Environmental Addressing Environmental Health Issues in AlaskaHealth Issues in Alaska

Respond to community calls for assistance Conduct community-based participatory research (CBPR) Ensure community right-to-know Advocate for health and justice through prompting of protective,

precautionary local, state, national and international policy changes Field and community health investigations GIS computer mapping

Toxic Waste Sites in AlaskaToxic Waste Sites in Alaska

The north has become a hemispheric sink for pesticides and other industrial chemicals

Northern food webs favor the deposition and retention of persistent, bioaccumulative toxics

Contaminants in the north threaten the health of peoples that rely on traditional diets of fish and marine mammals

Global warming enhances the mobilization and transport of contaminants from local and distant sources

Contaminants in the NorthContaminants in the North

The North is a Hemispheric SinkThe North is a Hemispheric Sink

Formerly Used Defense SitesFormerly Used Defense Sites

Elder Annie Alowa from Savoonga, Alaska, pictured at Formerly Used Defense Site on St. Lawrence Island

Where is St. Lawrence Island?Where is St. Lawrence Island?

Located in the Pacific Ocean, between Russia and the U.S.

Disease PatternsDisease PatternsObserved on St. Lawrence Island Observed on St. Lawrence Island Cancers Thyroid disease Diabetes Heart disease Low birth weight babies, premature births, still births, miscarriages Other reproductive health problems

PCBs in Blood Serum of PCBs in Blood Serum of St. Lawrence Island PeopleSt. Lawrence Island People

Levels of PCBs in the blood of St. Lawrence Island Yupik people 6-9 times higher than average in lower-48 populations

Evidence of PCBs accumulating in the Arctic via global transport

Military contamination also a significant source

Published in the International Journal of Circumpolar

Health (Carpenter et al., 2005)

Total Average PCB

0

2000

4000

6000

8000

10000

12000

Gambell NE Cape Savoonga

Co

nce

ntr

atio

n (

pg

/g)

Average for populations in the lower-48

Formerly Used Defense Sites in Formerly Used Defense Sites in Norton Sound, AlaskaNorton Sound, Alaska

Specific AimsSpecific Aimsfor Environmental Health and Justice for for Environmental Health and Justice for

Norton Sound, Alaska Project Norton Sound, Alaska Project Identify sources of contaminants, including

those from military and long-range, atmospheric sources

Describe past and current health problems Increase the capacity of the health care

system in Norton Sound to properly diagnose and treat health effects linked with environmental contaminants

Work toward responsible cleanup of contaminated sites and prevent new sources of contaminants 

Assist Norton Sound communities in securing training and tools needed to establish independent programs operated by the villages to monitor contaminants

Project partners: 15 Villages in Norton Sound Region State University of New York Alaska Community Action on Toxics Norton Sound Health Corporation Other researchers at Clarkson

University, St. Lawrence

University, Environment

Canada, Health Canada,

University of Alaska,

National Marine Fisheries

Service, and University of

California

Environmental Health and Justice Project Environmental Health and Justice Project for Norton Sound, Alaskafor Norton Sound, Alaska

(above) Morgan Apatiki, Community Health Researcher from Gambell, AK, collecting food samples for our Traditional Food Study

(upper right) Student testing water quality in Nome, AK during 2008 Field Institute

(right) Field sampling in Elim, AK, 2007

Environmental Health ProgramsEnvironmental Health Programs

Training for community health and field researchers

Field Institute Quarterly seminars for Village

Health Aides & other health care professionals

Environmental Health Care Toolkit Alaska Collaborative on Health and the

Environment

Independent research informs clean-up decisions

Promoting proper diagnoses and treatment of environmental health effects

Better oversight and holding military accountable for clean up

Influencing public health policy to prevent exposures from this and other formerly used defense sites and long-range transport

Community Health Implications of Community Health Implications of Norton Sound ProjectNorton Sound Project

Reproductive Health and the Reproductive Health and the EnvironmentEnvironment

“…exposure to low-level contaminants may be subtly undermining our ability to reproduce.”

Environmental Health Perspectives, journal of the

National Institute of Environmental Health Sciences 2006

Health of Arctic Children Health of Arctic Children ThreatenedThreatened

““Alaska Native infants Alaska Native infants have a much higher rate of have a much higher rate of

hospitalization for infection than hospitalization for infection than any other group of U.S. infants… any other group of U.S. infants…

Prenatal exposure to Prenatal exposure to contaminants, which are known contaminants, which are known to affect the developing immune to affect the developing immune

system, could play a role, system, could play a role, and that possibility is and that possibility is now being examined.”now being examined.”

-Dr. Jim Berner, pediatrician, Alaska Native Dr. Jim Berner, pediatrician, Alaska Native Tribal Health ConsortiumTribal Health Consortium

Birth Defects in AlaskaBirth Defects in AlaskaData from the Alaska Birth Defects Registry

shows: Birth prevalence of major congenital anomalies in

Alaska is twice as high as in the United States as a whole

Alaska Native infants have twice the risk of MCAs as white infants born in Alaska

Recommendations for women include: Avoid contact with known or suspected

environmental teratogens

“…even independent of differences in cigarette smoking, alcohol consumption and maternal age—which is a well-known

risk factor for birth defects—Alaska Natives still have an increased risk ... that we don't really know how to explain."

Dr. Bradford Gessner, Maternal and Child Health Epidemiology unit

Adverse Birth Outcomes Adverse Birth Outcomes Associated with Open Dumpsites Associated with Open Dumpsites

in Alaskain AlaskaMothers residing in villages with high hazard ranking were: 43% more likely to have a low birth weight baby 45% more likely to give birth prematurely More likely to have babies afflicted with intrauterine growth retardation

Gilbreath, S. and Philip Kass. 2006. American Journal of Epidemiology.

Chemicals Associated with Chemicals Associated with Reproductive Health EffectsReproductive Health Effects

Commonly-used pesticides Polychlorinated biphenyls (PCBs) Chemical additives (used in production

of plastics, e.g., bisphenol A) Perfluorinated compounds (used in

production of stain-resistant, water-repellant, or non-stick surfaces)

Chemical additives to beauty and self-care products (e.g. phthalates)

Polybrominated diphenyl ethers (PBDEs) (used as flame retardants in household upholstery and electronics)

Health Concerns associated Health Concerns associated with Metals Miningwith Metals Mining

Blasting, crushing operations mobilize toxic air emissions

Leaching of heavy metals into streams and rivers can harm fish and drinking water sources

Cyanide used in leaching process is lethal at very small doses

Negative effects on quality of life, social, cultural and emotional impacts

Lone Tree and Marigold Mines in NV—photo by Peter Essick

Toxics Release Inventory—Mines are Toxics Release Inventory—Mines are Among Largest Industrial Polluters Among Largest Industrial Polluters

of Toxic Chemicalsof Toxic Chemicals Red Dog Mine

533,421,591 lbs of toxic chemicals released in 2007 with increasing trend

Largest polluter in the nation, 4 times that of any other facility in the U.S.

Red Dog Mine-Ikalukrok Creek Junction

Environmental Health Care Environmental Health Care ToolkitToolkit

Designed for Village Health Aides in Alaska for use in clinics Purpose: To promote proper diagnosis, treatment, and prevention

of health problems linked to environmental contaminants in Alaska A work in progress… We welcome your feedback!

With about 1,000 pounds of dental equipment, a Dental Health Aide Therapist awaits a ride after traveling to Point Hope, AK by airplane.

Collaborative EffortCollaborative Effort

Village Health Aides provide village-specific information on prevalent exposures and diseases to cover in toolkit materials

EHC Toolkit Advisory Group (comprised of Community Health Aides, local physicians, and community field researchers) contributes to and reviews all toolkit materials

Annual Community Health Aide Program (CHAP) Forum Annual Alaska Tribal

Conference on Environmental Management (ATCEM)

Toolkit ContentsToolkit Contents Foreword Introduction Environmental Health History and Assessment Resources for More Information Environmental Health Care Fact Sheets

Household Toxics Hazardous Waste

Reference Cards on prevention of exposure for patients

Map of Villages and Federal Defense Facilities

Protecting Our Health in Alaska: a poster for clinics and homes

Symptoms of environmental exposures can be misdiagnosed as common symptoms of other diseases

Exposures can occur in the home, at work, from food and water, from hobbies, and from outdoor activities

Taking an environmental health history is important in determining if patients had an environmental exposure and making a correct diagnosis

Environmental Health History & Environmental Health History & Assessment FormAssessment Form

Environmental Health Care Environmental Health Care Fact SheetsFact Sheets

Fact sheets contain information about: what the contaminant is how exposure occurs symptoms of exposure what to do for patients showing exposure symptoms how to prevent or reduce exposure

Toolkit will 25-30 contain fact sheets on chemicals of concern in the Norton Sound region, including chemicals associated with household toxics, hazardous waste, mining, and FUDS

Reference CardsReference Cards Tips on how to prevent or reduce exposure Handouts for patients Example:

REDUCING YOUR EXPOSURE

You can minimize your exposure to bisphenol-A in the following ways:

• Use glass, stainless steel, or polyethylene bottles (PETE, PET, or #1; HDPE or #2; LDPE or #4) instead of polycarbonate (PC or #7) bottles.

• Avoid heating foods in polycarbonate containers, as bisphenol-A tends to leach faster with higher temperatures. Use glass or ceramic containers instead.

• Cut back on consumption of canned foods to reduce exposure to bisphenol-A contamination from the interior coating of the container. Also, avoid canned foods with higher fat content, which may have higher levels of bisphenol-A.

• Before getting dental sealants, check with your dentist about the ingredients in the products they use, as some formulations may leach bisphenol-A.

PosterPoster

Provides information on potential exposures

Tips on how to reduce exposures

Designed for clinics, waiting rooms, community buildings, and homes

Now available!

MapsMaps

Contains the Map of Villages and Federal Defense Facilities in the Norton Sound Region

Other statewide and regional maps of toxic waste in Alaska are available on ACAT website: www.akaction.org/Mapping.htm

Resources ListingsResources Listings Non-governmental organizations (NGOs) Government agencies Publications and other materials (books, websites, online

databases, etc.) Scientific journal articles and ACAT Health Bulletins

For Example:Alaska Community Action on Toxics (ACAT): www.akaction.org

Collaborative on Health & the Environment (CHE): www.healthandenvironment.org Access the CHE Toxicant and Disease Database:

database.healthandenvironment.org

Agency for Toxic Substances and Disease Registry (ATSDR): www.atsdr.cdc.gov

Pediatric Environmental Health Editor Ruth A. Etzel, MD and Associate Editor Sophie J. Balk, MD

Skin Deep Cosmetics Safety Database: www.cosmeticsdatabase.com

For more information, see full resources listings in toolkit

Additional ResourcesAdditional Resources

Journal Articles Polychlorinated Biphenyls in Serum of the Siberian Yupik People

from St. Lawrence Island, Alaska (Journal of Circumpolar Health) Adverse Birth Outcomes Associated with Open Dumpsites in

Alaska Native Villages (American Journal of Epidemiology) Health & the Environment Bulletins

Body of Evidence: Reproductive Health and the Environment Diabetes: The Role of Persistent Toxic Chemicals in this

Complex Disease

Any Questions?Any Questions?

Thank you!